Provider Demographics
NPI:1336505700
Name:WILLIAMSON, SIDONIA
Entity Type:Individual
Prefix:
First Name:SIDONIA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 SOUTH ALAMO AVE
Mailing Address - Street 2:BLDG 400
Mailing Address - City:DAVIS-MONTHAN
Mailing Address - State:AZ
Mailing Address - Zip Code:85708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4175 S. ALAMO AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-4405
Practice Address - Country:US
Practice Address - Phone:520-228-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care